Visudtibhan Anannit, Thampratankul Lunliya, Khongkhatithum Chaiyos, Okascharoen Chusak, Siripornpanich Vorasith, Chiemchanya Surang, Visudhiphan Pongsakdi
Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand.
Brain Dev. 2010 Nov;32(10):855-62. doi: 10.1016/j.braindev.2009.12.004. Epub 2010 Jan 13.
Migraine is a common childhood illness with expected favorable outcome. A study of the long-term clinical course of childhood migraine will provide information of evolution of migraine. A cohort study for 3-academic-year was conducted in Thai junior high-school children from July 2005 to February 2008 to determine the clinical course of migraine. Two hundred and forty-eight students in four junior high schools diagnosed with migraine according to ICHD-II in July 2005 were recruited. Each student was serially evaluated twice yearly from 7th grade during each semester of the academic year until the second semester of 9th grade. Determination of the characteristics, severity, frequency, and treatment of headache were obtained by questionnaire and direct interview. At the final evaluation, clinical course of headache was categorized into seven patterns. Among enrolled students, 209 (84.3%) completed the study. Twenty-eight (13.5%) students had no recurrent headache while that of 153 (73.5%) improved. No improvement of migraine and worsened migraine were observed in four students (1.8%) and 24 students (11.2%), respectively. Spontaneous remission and avoidance of precipitating causes contributed to relief of migraine in the majority of the students. Stress-related daily school activities and inadequate rest were reported as common precipitating factors among students with non-improving or worsening outcome. Chronic daily headache and tension-type headache was observed in 6 and 30 students, respectively. This study confirms that clinical course of migraine in schoolchildren is benign. Frequency and intensity of headache can be reduced with reassurance and appropriate guidance. Early recognition and appropriate prevention of migraine attack will decrease the risk of chronic migraine and disease burden.
偏头痛是一种常见的儿童疾病，预后通常良好。一项关于儿童偏头痛长期临床病程的研究将提供偏头痛演变的信息。2005年7月至2008年2月，对泰国初中学生进行了一项为期3学年的队列研究，以确定偏头痛的临床病程。招募了2005年7月在四所初中被诊断为偏头痛（根据国际头痛疾病分类第二版[ICHD-II]）的248名学生。从七年级开始，在学年的每个学期对每名学生进行每年两次的连续评估，直至九年级第二学期。通过问卷调查和直接访谈来确定头痛的特征、严重程度、频率和治疗情况。在最终评估时，头痛的临床病程被分为七种模式。在登记的学生中，209名（84.3%）完成了研究。28名（13.5%）学生没有复发性头痛，而153名（73.5%）学生的病情有所改善。分别有4名（1.8%）和24名（11.2%）学生偏头痛无改善和病情恶化。大多数学生的偏头痛缓解得益于自发缓解和避免诱发因素。与压力相关的日常学校活动和休息不足被报告为病情无改善或恶化的学生中常见的诱发因素。分别有6名和30名学生出现慢性每日头痛和紧张型头痛。本研究证实学龄儿童偏头痛的临床病程是良性的。通过安慰和适当指导，头痛的频率和强度可以降低。早期识别和适当预防偏头痛发作将降低慢性偏头痛的风险和疾病负担。
